How can you calculate your worth as a physician?

Wondering if your compensation offers are in line? So did I.

By Steven R. Bruhl M.D. and David A. Bruhl | Remarks


Finding a job right out of residency is a complicated and daunting task. Although many young physicians might think they have some idea about their expected income, they often have difficulty correctly assessing the effects of different practice settings and geographic regions on their relative worth.

Once a salary and sign-on bonus has been agreed on, many new physicians fail to ask exactly what measuring stick their employer will use to evaluate their productivity and corresponding future income.

My experience with finding the perfect job was no different, and as practices started sending me contracts and benefit packages the size of small phone books, the same questions kept running through my mind: How do I know what I’m worth? How do I know which contract offers are fair, and which are attempts to take advantage of my financial inexperience?

After several hours of sifting through the various contracts, I knew I was in over my head, so I met with the business manager in charge of the cardiology practice where I was completing my fellowship.

Almost immediately, she recommended I consult the same resource their practice and hundreds of other practices use for answering these questions: the Medical Group Management Association (MGMA) manual.

Every year, the MGMA sends out the Physician Compensation and Production Survey to medical practices in order to obtain current information about the compensation and productivity of physicians around the country.

These surveys are provided to all specialty types, practice structures and regions of the country. The results of these surveys are then organized and compiled into charts to help medical practices gauge their own productivity and compensation.

Medical groups often use this information to set their own internal benchmarks for establishing future compensation and productivity standards for current and new physicians.

What I learned from the MGMA manual was that, although there are a myriad of potential variables that go into what determines a physician’s salary, there are six major practice variables that are tracked and that appear to consistently affect a physician’s compensation. They are: practice ownership, group type, geographic section, demographics, partners in practice and call responsibilities.

I found that by using the information in the MGMA manual, I was further able to estimate the average salary of a specific job offer based on the characteristics of each practice.

For example, let’s assume you are an invasive cardiologist and receive three identical compensation packages from three different practices. Practice 1 is a non-hospital owned, single-specialty group type located in a large metropolitan city in the Eastern region, such as New York City.

Practice 2 is a non-hospital owned, single-specialty practice located in a smaller metropolitan city in the Midwest, such as Cincinnati.

Practice 3 is a hospital-owned, multispecialty practice group, located in a non-metropolitan city also in the Midwest, such as Dearborn, Mich.

The first step in determining the average salary of Practice 1 is to look up the average salary for an invasive cardiologist working in a city over 1 million people and record the value. Next, look up the average compensation for an invasive cardiologist working within that region of the country.

Do the same thing for an invasive cardiologist working in a non-hospital-owned practice setting as well as an invasive cardiologist working in a single-specialty practice.

If you add up the average salaries from all four variables and divide by four, you will get what is likely an even closer estimate of the average annual salary for an invasive cardiologist working in Practice 1.

If you then repeat this process for your other job offers, you can now compare the average expected salaries of all job opportunities side by side.

Although there is no doubt that this method is a relatively crude attempt to estimate the salary of a specific practice setting—and no doubt lacks dozens of variables important to the equation—the composite estimates are at their core based on actual reported salaries of physicians working in your specialty within each specific practice setting.

Although the process of averaging four different compensation values based on four different variables is imperfect, these values can help shed light on the current trends in compensation as well as your relative worth in a given practice setting.

In about an hour, I was able to construct a chart comparing the average expected compensation from my top three job offers. Although all of the initial salaries were within 10 percent of each other, I found that the proposed salary for my favorite was 25 percent lower than my estimate from the MGMA manual.

With this knowledge and the counsel of other advisors, I counter-offered for 25 percent more than my initial offer, plus a bonus salary based on my productivity.

To my somewhat surprise, the hospital agreed to my three-year salary proposal, but suggested that my bonus salary be based on a specific work revenue value unit standard, also known as wRVUs.

Their initial productivity goals seemed somewhat high and unrealistic to my lawyer and me. So by referring to the standards published in the MGMA manual for my specific practice structure, we were able to work out a wRVU standard that was more appropriate for my specific practice setting.

From my experience, I found the MGMA manual to be a powerful tool in sorting out my financial value across very different practice settings. However, I would advise anyone consulting the MGMA manual to remember that the data should be use as a general guide rather than as a weapon.

Furthermore, if your potential employer intentionally or unintentionally tries to suggest that your proposed compensation is out of proportion to the average for your area, you may be able to use information in the MGMA manual to show otherwise.

Don’t overlook call responsibilities when discussing your relative productivity. Because call responsibilities often generate little to no direct revenue, make sure this variable is not overlooked when discussing your relative productivity.

Each practice is unique, and it is impossible to tease out the exact value of any particular variable, much less the exact value of a physician in that practice setting. However, using the variables that are known and understanding how they tend to affect compensation will help you better approximate your worth in a given practice setting and take some of the guesswork out of the negotiation process.

Although the process of estimating your worth is somewhat tedious, time-consuming and expensive, I would urge every physician to take the time and spend the money necessary to consult with physicians, practice managers and a lawyer experienced in physician contract law.

In the end, every hour and every dollar spent will likely pay dividends that go far beyond your starting salary.

Steven Bruhl, M.D., is a third-year cardiology fellow at the University of Toledo Medical Center and will be taking a position as a cardiologist at Mercy Tiffin Hospital in Tiffin, Ohio. David Bruhl is a lawyer with Rohrbachers Cron Manahan Trimble & Zimmerman Co.

The views expressed in Remarks are solely those of the author and may or may not be shared by PracticeLink or its advertisers.



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Your Ultimate Job Search Guide

Gold Award winner for Best How-To Article from the American Society of Healthcare Publication Editors!

By Karen Childress | Feature Articles | Summer 2011


Elly Laroque, M.D., Orthopaedic surgeon

Elly LaRoque, M.D., suggests starting your job search at least a year in advance—earlier if you’re considering academics. She chose a medium-sized private practice after completing a sports medicine fellowship.

Click to download this article as a PDF

Orthopaedic surgeon Elly LaRoque, M.D., has given lectures to residents and fellows from Stanford, UCSF, and at American Academy of Orthopaedic Surgeons annual meetings on how to choose and start a practice. The content of her presentations is based on her own experience, research, and from talking to her colleagues who share accounts of their job searches. Her most valuable piece of advice? “Start looking early, at least a year in advance, unless you’re going into academics, in which case start even sooner,” says LaRoque.

But how early is early? And how do you know what to do, and when? These are the questions that this article seeks to address in a way that will make your job search relatively smooth and painless.

The process can seem daunting and drawn out, but if you take it one step at a time, the end result will be—if all goes according to plan—your ideal job. more »


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Make a conference connection

Your next CME conference could lead to your next opportunity

By Margaret Lokey | Job Doctor | Summer 2011


How many times have you seen an ad or direct mail piece for a physician conference at some far-off location and thought, “That would be a nice getaway.” Or maybe you’ve seen conferences as an opportunity to obtain CME credits, increase your knowledge base and network with colleagues. But have you ever thought of a national conference as a possible gateway to a new life and new opportunities? You should, because many of your fellow physicians have already made this discovery.

If you are a physician looking for a change, attend conferences prepared to know what information to gather and which questions to ask as you make your way from booth to booth.

Depending on the conference you attend, you’ll most likely meet individuals representing large hospital companies, individual facilities, online career services, recruitment firms, and/or locum tenens organizations. Each of these groups can offer information and assistance in your search for an ideal job.

Savvy exhibitors with current openings will not only have general information about their organization and what they can provide, but also specific information about available positions.

National conferences are large and tend to be fast-paced and busy, so be prepared to collect information relevant to your needs and expectations. By collecting information from the booths, you have the option to either return to your hotel room to absorb the content when you have more time or to review it once you have returned home.

Prepare a list of questions to ask representatives from each company. Asking a question not only allows you the opportunity to find a position that might be a perfect fit, but it also positions you as a more memorable candidate for the recruiter.

Though questions will differ from physician to physician, the advice remains the same: Make sure to have your questions written down, and don’t hesitate to take notes.

Your questions may range from work-related questions, such as “How many nights each month would I be expected to take call?” or “How fast do you think my practice will grow?” to questions regarding aspects outside the job, such as “What are the school systems like in the area?” or “What are some outside activities offered in and around the location?” The representatives at each booth are excited to talk with you and should have all this information and more to provide. more »


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Organizational culture: Physician satisfaction and success

You might have all the right skills, but will you fit in with the culture?

By PracticeLink Staff | Web Exclusive


Where is the practice located? How much compensation will I receive? What type of practice is the opportunity?Workplace culture and physician satisfaction

These are just a few of the questions, as physicians, you might ask yourself when you begin your search for the right practice opportunity. There’s an even bigger question you should consider, and one that employers may be asking of you.  “Are you a good fit for the organization, socially and culturally?”

Organizations and even medical schools, like Virginia Tech Carilion, are conducting pre-screenings to help determine if candidates will be a good match, socially and culturally. Virginia Tech Carilion uses a method called multiple mini interview, or M.M.I., and its use is spreading.  Check out this recent article by The New York Times, New for Aspiring Doctors, the People Skills Test.

Organizational culture, that mysterious word that characterizes a work environment, can mean just as much to a recruiter as a physician’s credentials. Behavior assessments give a recruiter an idea of how well a physician will fit in with the organization and also within the community they’ll be serving.

As job seekers, you should also consider cultural fit when searching for your first or next practice, or even when looking for a partner for your medical practice. more »


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Job Search Tips for Physicians

PracticeLink recruiters reveal tips they wish more candidates would heed.

By PracticeLink Staff | Web Exclusive


Ever wonder exactly what physician recruiters are looking for in a candidate? Wish you had the inside scoop on how to get a leg-up in your search for the right practice?

Panel of physician recruiters

PracticeLink physician recruiters share their tips for candidates who are looking for a job.

PracticeLink recently hosted a panel of physician recruiters to get their take on what’s important in their search for the right candidate. Residents, fellows, NPs/PAs, and even practicing physicians can benefit from what they had to say.

We’ve captured some of their tips and suggestions here:

Your C.V. and cover letter:

  • Tailor your CV and cover letter to the job you’re applying for.
  • There are no absolute rules but, in general, the length of your CV depends on your profession. For example, clinical CVs tend to be shorter, while academic CVs are typically longer in length.
  • Stay on top of your CV and make sure it’s up to date.
  • Focus the content of your CV on your career objective, highlights of your career to date, education and major skills and accomplishments. more »


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How to make the most of your interview

Ask about referral patterns, technology and the group’s financial stability when interviewing for your first or next practice

By Lisa Vognild, FASPR | Job Doctor | Spring 2011


Taking time away from training or a busy practice to interview for a position takes a significant investment of your time. With travel, most interviews will require two or three days.

Being prepared with a list of questions to ask—both before you accept an interview and during the interview itself—will help you make the most of your time and leave the interview thoroughly informed.Quote

You will be asked by almost everyone that meets you, “Do you have any questions?” Having a list on paper will prevent you from having to come up with them on the spot. Also, it will show each interviewer that you are engaged in the process, are prepared, and have a genuine interest in the opportunity.

You will find that, after several interviews, the information from each place will start to run together. You will ask yourself, “Was that at that place or the other place?” So during your interview, jot down a few notes to refer back to later. More importantly, at the end of your visit, write a brief summary of the pros and cons and any uncertainties you have. more »


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Your Green Job Search

Does being green matter to you? Then make green initiatives something you look for in your job search, too.

By Sally Herigstad | Feature Articles | Spring 2011


Susan Gamble, M.D.

“…Someone who is able to take a green initiative for their office probably has it all together so they’re able to focus on the environment,” says Susan Gamble, M.D., a third-year internal medicine resident at Yale who is considering how the environment will play into her own job search.

Susan Gamble, M.D., a third-year internal medicine resident at Yale, is job hunting. She’s looking at many factors as she decides where to practice, but at first glance, the greenness of a practice or facility isn’t necessarily one of them.

That’s not to say she isn’t concerned about the environment.

“I want to be somewhere where I can control it (environmental responsibility) in my own life,” she says. “At work, I haven’t thought about it.”

But after talking about environmental consciousness and health care, Gamble is more inclined to consider it as a criterion.

After all, it’s a good sign the practice is paying attention to other things, as well.

“It’s impressive, because you think someone who is able to take a green initiative for their office probably has it all together so they’re able to focus on the environment,” Gamble says.

Green practices may sound like code for solar panels and recycling bins, or perhaps waste management. Environmentally responsible initiatives in medical practices and hospitals go far beyond stereotypical “green” projects, however.

Take Denver Health, for example. When the health care organization built the new Park Hill Family Health Center, which opened in 2009, they designed it to reduce heat and energy consumption, according to spokesperson Chris Poisson. But they didn’t stop there. more »


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10 signs of a well-run practice

Questions to help you decide how well a practice is run

By Teresa Odle | Feature Articles | Spring 2011 | Uncategorized


Jill Stoller, M.D., managing partner

A lot of young physicians have their eyes opened when they get into a practice that they haven't evaluated," says Jill Stoller, M.D., managing partner of Chestnut Ridge Pediatric Associates in Woodcliff Lake, N.J.

Location, location, location. Along with compensation, it’s one of the first considerations when physicians job search. But you can golf most anywhere and ski in most northern and Rocky Mountain states. Even if you return to your hometown, you might have several practice opportunities from which to choose. So don’t overlook how well a practice runs when researching places to work.

Most physicians would agree that resident programs don’t prepare physicians well for the business side of medicine. Jill Stoller, M.D., FAAP, managing partner of Chestnut Ridge Pediatric Associates in Woodcliff Lake, N.J., says there isn’t much emphasis on practice management. “But I think it may be changing a little bit,” says Stoller, who also chairs the American Academy of Pediatrics’ Section on Administration & Practice Management. “A lot of young physicians have their eyes opened when they get into a practice that they haven’t evaluated.”

Physicians don’t better vet practices because they may lack the business savvy to do so or they run out of time. Many simply must adjust after so many years in medical school and residency. Ryan Mire, M.D., FACP, is an internal medicine physician with a multispecialty practice in Nashville, Tenn., who has been in private practice since 2002. more »


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Akash Sharma, M.D.

By PracticeLink Staff | Snapshot | Winter 2011


Akash Sharma, M.D., with his daughters

Assistant professor, Mallinckrodt Institute of Radiology, Washington University, St. Louis, Mo.

MEDICAL SCHOOL: Ross University School of Medicine, West Indies
RESIDENCY: Hartford Hospital, Hartford, Conn.
FELLOWSHIP: One-year fellowship in nuclear radiology after general radiology residency

Married with three daughters, including a set of twins. Hobbies include travel, photography, reading, being a tech junkie and studying. Sharma just finished an MBA program and plans to study finance and writing next. more »


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Coming to (and staying in) America

For citizens of other countries, the road to a residency in the United States is full of jargon, applications, lawyers and anxiety. Nevertheless, opportunities abound, and the welcome mat is out.

By By Lester Picker | Fall 2010 | Feature Articles


Latha Achanta, M.D.

"As I was nearing the end of my residency, I looked for a place that would continue my H-1B and would be willing to sponsor my green card. I was fortunate to secure a position at the University of Arkansas for Medical Sciences." - Latha Achanta

For Latha Achanta, M.D., it was a tense time fueled by the anxiety that one mistake could threaten her future as a physician. Fresh off a master’s degree in public health from the University of Texas, Achanta was in the United States on an F-1 student visa at the time. A native of India, she was applying for her H-1B visa to train in a United States hospital in internal medicine.

“Initially, the process was anxiety-producing,” says the 29-year-old Achanta, who recently completed her third year of residency at Abington Memorial Hospital in Pennsylvania.

The United States allows International Medical Graduates (IMGs), also known as Foreign Medical Graduates (FMGs), the opportunity to train in American medical institutions, as long as they meet minimum entrance requirements. Due to the undersupply of graduates from American medical schools, especially ones willing to go into family practice or internal medicine, this arrangement has historically benefited both the foreign physician and the hospitals.

Should you do J-1 or H-1B?
Two types of visas are offered to IMGs: the J-1 and the H-1B.

Most IMGs prefer the H-1B visa. The reason is simple: Those arriving on J-1 visas have up to seven years to complete their training. But after that time period, they must return to their home countries for at least two years or else file for what is known as a J-1 waiver.

The J-1 waiver has a major restriction that makes it less than desirable for many foreign physicians. To qualify, the recipient must serve for at least three years in a U.S. Medically Underserved Area (MUA), a Health Professional Shortage Area (HPSA), or a Medically Underserved Population (MUP). This alone might not be a significant barrier, but openings might not be available in their practice specialties or preferred geographic areas.

The H-1B has no such return provision and can be renewed, but it is considerably harder to obtain, says Robert Lubin, an immigration attorney for more than 25 years and founder of Robert Lubin & Associates in Herndon, Va. “For one thing, the H-1B requires that the IMG first pass the United States Medical Licensing Exam,” Lubin points out.

Muhammad Balouch, M.D., a 32-year-old internal medicine resident at Mount Sinai School of Medicine’s Veterans Affairs Medical Center in the Bronx, N.Y., chose the H-1B route. “You avoid having to go back home or getting an exemption,” says Balouch. “The H-1B is the quicker route to a green card.”

The IMG journey
In all cases, the process begins with an application to the Educational Commission for Foreign Medical Graduates (ECFMG), a United States organization that oversees the process of certifying the credentials of IMGs for entry into U.S. residency training. All IMGs, regardless of citizenship, must be ECFMG Certified in order to begin U.S. residency training.

IMGs, like graduates of U.S. programs, use the Electronic Residency Application Service (ERAS) to submit application materials to U.S. training programs. Competition for U.S. residency slots is highly competitive and a substantial hurdle for many IMGs.


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